Adaptive Interventions to Reduce Risky Drinking and Violent Behaviors among Adolescents

减少青少年危险饮酒和暴力行为的适应性干预措施

• 批准号: 9080141
• 负责人: REBECCA M. CUNNINGHAM
• 金额: $ 61.92万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-15 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9080141
• 关键词: Accident and Emergency department; Adolescent; African American; Age; Alcohol consumption; Alcohol or Other Drugs use; Caucasians; Cause of Death; Conditioned Reflex; Data; Development; Drug usage; Economically Deprived Population; Emergency department screening; Emergency department visit; Event; Future; Gender; Health; Heterogeneity; High School Student; Homicide; Individual; Intentional injury; Intervention; Maintenance; Measures; Methodology; Morbidity - disease rate; Outcome; Participant; Physical aggression; Public Health; Randomized; Reporting; Research; Resource Allocation; Resources; Risk; Risk Behaviors; Severities; Specific qualifier value; Staging; Technology; Teenagers; Testing; Text; Time; Translations; Treatment Efficacy; Victimization; Violence; Work; Youth; age group; alcohol misuse; alcohol related consequences; alcohol use disorder; arm; base; binge drinking; brief alcohol intervention; brief intervention; comparative efficacy; cost; drinking behavior; efficacy testing; emerging adult; high risk drinking; innovation; mortality; personalized approach; personalized intervention; primary outcome; public health relevance; randomized trial; reduced alcohol use; response; secondary outcome; socioeconomics; trial design; underage drinking

 DESCRIPTION (provided by applicant): Underage drinking and violent behaviors (i.e., physical aggression) are prevalent among adolescents and emerging adults, with enormous impact on morbidity and mortality, particularly among youth residing in socio- economically disadvantaged urban settings. An urban Emergency Department (ED) visit provides an opportunity for identifying youth involved in these comorbid risk behaviors and delivering interventions to alter risk trajectories. Despite promising findings from our prior work (the SafERteens Study), which demonstrated the efficacy of an ED-based brief intervention (BI) for alcohol and violence on reducing alcohol-related consequences and violent behaviors, the public health impact of single session BIs is limited by modest effect sizes. Further, there is a critical lack of data regarding how to optimize interventions to have maximal impact with parsimony of resources. Sequential, multiple assignment randomized trial (SMART) designs provide an innovative methodology to compare the efficacy of just-in-time adaptive interventions [(text messaging (TM) or remote health coach (HC)] for adolescents based on response/non-response. To date, such personalized adaptive interventions have not been applied to risky drinking and/or violent behaviors among youth. The proposed study harnesses technology which is particularly appealing to youth, for facilitation of just-in-time delivery of adaptive interventions (AIs). Thus, the specific aims are to: 1) Compare the efficacy of AIs that begin with BI+TM vs. BI+HC on reducing alcohol misuse and violent behaviors among youth while in the ED; and, 2) Identify the most efficacious second-stage strategy post-ED visit for those who initially respond and for those who do not. Specifically, 700 youth (ages 14-20) in the ED screening positive for alcohol use and violent behaviors will be randomly assigned to: BI+TM or BI+HC. After receiving the SafERteens BI in the ED, youth will complete weekly text assessments over an 8 week period to tailor intervention content and measure mechanisms of change, with one month determination of participant response (e.g., binge drinking, violent behaviors). Responders in each arm will be re-randomized to continued condition (e.g., maintenance), or reduced condition (e.g., stepped down). Non-responders will be re-randomized to continued condition (e.g., maintenance), or intensified condition (e.g., stepped up). Outcomes will be measured at 4, 8 and 12 months post-baseline. The AIs will be packaged to maximize future translation, with cost data provided (e.g., total implementation cost, cost per event averted). Secondary aims are to: 1) Compare and contrast pre-specified embedded AIs in terms of primary and secondary outcomes; and, 2) identify baseline and time-varying moderators of AI efficacy. Given the morbidly/mortality associated with alcohol use and violence, the proposed study will have significant public health impact by embedding a comparative efficacy study, testing state-of-the- art intervention delivery approaches (text messaging, remote therapy), within a SMART design to identify the optimal intervention strategy to produce and sustain outcomes among at-risk youth.

 描述（由适用提供）：青少年和新兴成年人中普遍存在未成年人饮酒和暴力行为（即身体侵略），对发病率和死亡率的影响增强，尤其是在居住在社会经济上处于贫困的城市环境中的青年中。城市急诊室（ED）的访问为确定参与这些合并风险行为的年轻人提供了机会，并提供干预措施以改变风险轨迹。尽管我们先前的工作（Saferteens研究）有望发现，这证明了基于ED的简短干预（BI）对酒精和暴力行为对减少酒精相关的后果和暴力行为的有效性，但单次会议BIS的公共卫生影响受到适度效应量的限制。此外，关于如何优化干预措施以最大程度地影响资源，存在有关如何优化干预措施的数据。顺序，多次分配随机试验（智能）设计提供了一种创新的方法，可以比较即时适应性的干预措施的效率（（（TM消息传递（TM）或远程健康教练（HC）），基于反应/无反应的青少年。迄今为止，基于反应/无反应的青少年。迄今为止，对于这种个性化的自适应尚未提出尤为适用于年轻人的饮酒和暴力行为，以下是Youth Is Privation the Privation the Privation in Yourgity Is Yount of Field tabore the Crapii in Yourt of Fiperii depripiors，促进自适应干预措施的及时交付（AIS）。 在ED中，BI+TM与BI+HC有关减少青年人的滥用酒精和暴力行为；以及2）确定最初回应的人和没有做出回应的人最有效的第二阶段策略。具体而言，在饮酒和暴力行为的ED筛查中，有700名青年（14-20岁）将随机分配给：BI+TM或BI+HC。在ED中获得Saferteens BI之后，青年将在8周内完成每周的文本评估，以量身定制干预内容和测量变化的机制，并确定参与反应的一个月（例如，Bbinge饮酒，暴力行为）。每个手臂中的响应者将被重新转换为持续状况（例如维护）或减少状况（例如，逐渐下降）。非响应者将被重新转换为持续条件（例如，维护）或受启发的状况（例如，逐渐下降）。向上）。结局将在基线后4、8和12个月进行测量。 AIS将包装以最大程度地提高未来翻译，并提供成本数据（例如，实施总成本，避免每个事件的成本）。次要目的是：1）根据主要和次要结果比较和对比预先指定的嵌入AI； 2）确定AI效率的基线和时变的主持人。鉴于与酒精使用和暴力相关的病态/死亡率，拟议的研究将通过嵌入比较有效的研究，测试最先进的干预交付方法（文本消息，远程治疗），在智能设计中识别出最佳干预策略，以确定生产和维持高风险的年轻人的最佳干预策略，从而产生重大的公共卫生影响。